Individual
MR. KEITH DENTON FISHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
909 9TH AVENUE, #404, FORT WORTH, TX 76104-3918
(817) 332-1782
(817) 336-8619
Mailing address
909 9TH AVENUE, #404, FORT WORTH, TX 76104-3918
(817) 332-1782
(817) 336-8619
Taxonomy
Speciality
Code
Description
License number
State
207WX0107X
Retina Specialist (Ophthalmology) Physician
Primary
H2374
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
117768501
—
TX
01
—
180039966
RAILROAD MEDICARE
—
01
—
4307768
AETNA
—
01
—
751869812
COMMERCIAL INS
—
Enumeration date
10/31/2005
Last updated
04/07/2017
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